2020

Vascular Access Device

Care and Management
A COMPREHENSIVE ORGANIZATIONAL APPROACH

AUTHORS

BRITT M. MEYER, PhD, RN, CRNI®, VA-BC, NE-BC

DAWN BERNDT, DNP, RN, CRNI®

MICHELE BISCOSSI, MS, RN, ACNP-BC, CNL, VA-BC
MELANIE ELD, PhD, RN

GINGER GILLETTE-KENT, MSN, MBA, RN, APRN, ANP-BC, NE-A

ANGIE MALONE, DNP, APRN, ACNS-BC, OCN, AOCNS
LORELLE WUERZ, PhD, MSN, RN, VA-BC, NEA-BC
T
EXECUTIVE SUMMARY

he Infusion Nurses Society (INS) asserts that a comprehensive organizational approach

to vascular access device (VAD) care and management is imperative to ensure safe and

efficacious patient care. The following challenges were evidenced through literature

review and addressed in this INS white paper:

• Utilization of practice bundles has demonstrated improvement in lowering infection rates

associated with VAD insertion, care, and management.1-3

• Current literature indicates VAD-associated complications persist. VAD practice

variation and lack of standardization is still a challenge that continues to jeopardize

patient safety.4-7

• Complexity of patient care includes multiple transitions of care and settings,8 and is

complicated by a myriad of VAD care products selected uniquely for each setting.

• Outcome data is essential and must be collected, analyzed, and utilized to change clinical

practice at the organizational level.9

Health care organizations must be prepared to address lack of standardization in VAD care and

management. It is essential that each organization (1) develops policies and procedures to align

VAD care and management with recognized standards of practice; (2) integrates unique aspects

of organization-selected VAD care products into policies and procedures and establishes

expectations for adherence to these organizational directives; (3) develops a framework for

gathering and analyzing clinical data related to patient outcomes for VAD care and management;

(4) utilizes quality outcome data to facilitate evidence-based best practices within the

organization; and (5) evaluates and facilitates educational programming to validate clinician

competency.

1
BACKGROUND AND SIGNIFICANCE

VADs are widely used in a variety of clinical settings to infuse solutions and

medications, obtain blood samples, monitor hemodynamic status, and perform therapeutic

phlebotomy and other therapies. The term vascular access refers to cannulation into the vascular

system either through the venous or arterial approach with the cannula tip dwelling peripherally

or centrally. The term VAD refers to all types of vascular access devices; CVAD refers to devices

that are exclusively central vascular access devices. Core elements of care and management are

applicable to all VAD types.

In recent years, efforts to reduce the occurrence of central line-associated bloodstream

infections (CLABSIs) focused on bundling evidence-based infection prevention interventions

and standardizing CVAD insertion practices. These efforts have reduced CLABSIs in the United

States by 50% during the last 20 years.1 A meta-analysis of the literature from 1990 to 2015

showed that implementation of VAD insertion and/or management bundles reduced CLABSI in

critically ill patients of all ages.2 Sustained reductions in CLABSI rates over a 14-month period

in 30 long-term, acute care hospitals were demonstrated after implementing a team for CVAD

care, adopting a new product for needleless connector disinfection, and auditing compliance of 6

bundle elements.3

Despite these improvements with a bundled practice approach, infections and other

complications related to inconsistent VAD care and management continue to threaten patient

safety. Variation in VAD care and management practices are widely reported; experts assert that

variation in practice is largely due to a lack of well-designed qualitative and quantitative research

to inform clinical practice.4-7 Standardizing practice for care and management is further

complicated by the variety of vascular access products and supplies, clinician-preferred

2
practices, and the variables presented in each health care organization. Patient care is managed in

a variety of settings often with multiple transitions between acute care, alternative care, and

home care settings. Accordingly, care coordination and practice standardization have become

more challenging yet imperative.8

These challenges provide organizations the opportunity to develop VAD policies and

procedures that adhere to recognized standards of practice while integrating information and

instruction of VAD care products unique to each care setting. Additionally, clinical practice must

be informed through outcome data obtained within the organization. Frameworks for obtaining,

analyzing, and applying these data for policy and procedure development are needed to improve

quality of care and patient experience.9

TASK FORCE DEVELOPMENT

INS receives frequent queries from clinicians requesting guidance on VAD care and

management procedures. In response, INS convened a task force charged with the following

responsibilities: (1) review and analyze current VAD-related literature and associated national

guidelines and standards of practice; (2) outline clinical practice recommendations according to

evidence reviewed; and (3) offer tools for VAD care and management, data collection, and

policy and procedure development.

The task force consisted of registered nurses who are experts in infusion therapy and

practice in a variety of clinical settings. Each member was either directly involved in VAD care

and management, education, and/or the evaluation of organizational performance of VAD care

and management.

3
PURPOSE STATEMENT

This INS white paper was prepared to provide guidance and a framework for developing

organizational policies and procedures, and tools for VAD care and management and data

collection. Though bundled interventions have been shown to improve infection rates, this white

paper does not outline specific VAD management bundle interventions since many postinsertion

bundles have been successfully implemented, each identifying varying components.3,10-15 Rather,

the intent is to provide tools that guide clinicians to safe, effective, evidence-based VAD

management practices that are applicable to their specific practice setting.

LITERATURE REVIEW

A review of literature was performed using PubMed/Medline and CINAHL databases.

Key terms included: bundle interventions, central line-associated bloodstream infection, vascular

access device failure, and complications associated with vascular access and intravenous (IV)

infusion devices. Data filters were applied to include only peer-reviewed articles written in

English between 2006 and 2019. Clinical guidelines, research studies, and expert reports were

included in the literature review process.

Evidence-based guidelines or standards for VAD care and management have been

developed through numerous organizations. The task force reviewed the following sources:

• Infusion Therapy Standards of Practice (the Standards), Infusion Nurses Society

(INS)16

• Guidelines for the Prevention of Intravascular Catheter-related Infections, Centers

for Disease Control and Prevention (CDC)17

• Access Device Standards of Practice for Oncology Nursing, Oncology Nursing

Society (ONS)18

4
 • A.S.P.E.N. Parenteral Nutrition Safety Consensus Recommendations, American

Society for Parenteral and Enteral Nutrition (ASPEN)19

• A Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute

Care Hospitals: 2014 Updates. Association for Professionals in Infection Control and

Epidemiology (APIC), Infectious Diseases Society of America (IDSA), Society for

Hospital Epidemiology of America (SHEA)20

HAND HYGIENE

Although there are many examples of gaps between evidence and practice that lead to

complications with VADs, hand hygiene represents a consistent and on-going gap. Despite the

importance of hand hygiene in preventing morbidity and mortality in health care, research shows

that health care workers do not practice appropriate hand hygiene. One study cited figures of

only 40% adherence.21 Poor compliance numbers have remained relatively steady over the years,

despite many research studies and interventions. Compliance with hand hygiene is improved

when standard mechanisms for auditing compliance are established and dissemination of the

results occurs in multiple forums to raise awareness and promote accountability.22 Incorporating

process and outcome structure in policy for hand hygiene as it relates to vascular access is

essential given the known preventative impact of hand hygiene in interrupting the potential for

pathogen transmission.

VAD COMPLICATIONS AND NEGATIVE OUTCOMES

Vascular access, whether central or peripheral, is an integral component of delivering

therapeutic treatments. Although often necessary for therapeutic intervention, VADs are also

frequently associated with complications that represent patient harm and financial burden.

Complications leading to negative outcomes may include failed vascular access insertion

5
attempts, bloodstream infection, infiltration or extravasation, dislodgment, occlusion, mechanical

failure, phlebitis, and thrombosis.5,23-25

The literature defines any negative outcome associated with peripheral IV access as an IV

failure. Prevalence of IV failure varies from 12% to 50% for all peripheral catheter types.5,25-27

With the exception of device malfunction, peripheral VAD failure is associated with human

error, clinical judgment, and differing scopes of practice and levels of competency for device

insertion and care. 27

CLABSI REDUCTION THROUGH APPLIED QUALITY DATA

CLABSIs are associated with increased mortality and morbidity and are known to

increase the cost of providing care in intensive care units.28 Several studies have shown that

competent decision-making by clinicians inserting and caring for VADs decreases device failure

and complications.7,11,29

Additionally, Govindan et al30 described poor clinician comprehension of quality metric

data which makes it difficult to interpret the results and make practice changes that improve

outcomes related to complications. The study showed that 43% of the respondents thought that

quality metric data for CLABSI, such as infection incidence and rates, were complex and

unreliable. Hence, clinicians benefit from explicit, best practice information that is readily

available for clinical use. A focus on providing structured processes can produce higher fidelity

and influence complications caused by improper or varying practice.31

RISKS ASSOCIATED WITH VAD ACCESS

Risks associated with access of VADs include the potential for intraluminal and

extraluminal contamination, loss of patency, catheter failure, and/or erroneous laboratory values

associated with adsorption of infused medications.5,32,33 In theory, the more times a catheter is

6
accessed, the higher the risk for introduction of pathogens that can result in lumen colonization

and subsequent infection.

Minimizing the number of entries into the vascular access system is an important risk-

reduction strategy.18 System entrance is defined as any manipulation of the system to infuse

medications or solutions, withdraw blood, and/or change administration sets and add-on devices

including needleless connectors. In order to take advantage of this risk reduction strategy, entry

into the VAD at any point on the infusion system should be performed when it will add value to

the plan of care and not merely for convenience. Critical thinking related to entering or

manipulating the entire infusion system can be developed through education and practice.34

VAD PATENCY, OCCLUSION, AND BLOOD SAMPLING

Catheter patency is described as the ability to flush the device without resistance and

presence of a blood return.35 Occlusion can be defined as (1) lack of free-flowing blood return,

(2) inability to infuse fluids, (3) increased resistance when flushing, or (4) sluggish flow.

Occluded catheters delay therapy and may act as a nidus for infection when the occlusion is

thrombotic. Since catheter patency is essential for safe and timely infusion therapy, guidelines

for assessing VAD patency and treating occlusions to reestablish patency must be included in

organizational policies and procedures.

Though obtaining laboratory samples from CVADs is a common practice, it can lead to

catheter occlusion and fibrin deposits in the lumen which can also be a nidus for infection.

CVADs requiring alteplase to treat catheter occlusions have been shown to be positively

correlated with catheter-related bloodstream infections (CR-BSIs).36-37 When a catheter is

inserted directly through the layers of skin, microbes attach to the catheter surface. In addition,

white blood cells, platelets, and plasma proteins also attach to the catheter surface. Fibrin strands

7
form as an early physiologic response to the catheter and often attach to the adjacent vein wall as

well as the catheter. The fibrin strands can become a sheath that acts as a host site for newly

arriving bacteria as well as continued clot formation.38 However, it remains essential to assess for

blood return even considering this discussion of potential risks related to blood sampling from

CVADs. It is important to remember that the length of time the blood remains in the catheter and

proper flushing will affect the amount of plasma proteins that attach to the catheter lumen.

The Standards recommends carefully analyzing risks versus benefits before using VADs

for obtaining blood samples.16 Risk-benefit assessment is needed for each entry into the infusion

system, including access for blood sampling, to ensure that the benefit outweighs the risks. If

after careful assessment, the patient has limited peripheral vasculature, or a history of vasovagal

reaction to needle punctures, obtaining blood specimens through a CVAD may be worth the

additional risk. However, drawing blood samples from a CVAD “to save the patient a

venipuncture” or for mere convenience, may increase the risk of CR-BSI. In such cases,

peripheral venipuncture may be the less risky option.18 It is important to educate patients and

families about the associated risks involved in blood sampling. Clinicians should also be

comfortable initiating a discussion with both the provider and the patient to examine how the

laboratory results will direct patient care, and to weigh the risk-benefit ratio of obtaining the

samples from VADs. Careful consideration of vessel preservation must be incorporated in the

risk assessment.

BIOFILM FORMATION, SECUREMENT, AND VAD NECESSITY

All catheters attain some level of biofilm within 24 hours of insertion.39 Biofilms are

sticky, mucopolysaccharide substances secreted by microorganisms that allow microbes to stick

to each other and to catheter surfaces. Improper VAD insertion and care and management

8
practices can affect how many organisms are available for biofilm formation on intraluminal and

extraluminal catheter surfaces.40 Even with appropriate skin antisepsis prior to catheter insertion,

microbes in the deep layers of the skin around the hair follicles and sweat glands can attach to

the extraluminal surface of catheters on insertion. Inadequate stabilization and securement of the

VAD can lead to back and forth catheter movement in the vessel and biofilm dissemination from

the extraluminal surface.

Accordingly, proper securement, assessment of catheter necessity, and removal of

unnecessary catheters can mitigate infection risk. Intraluminal biofilms are associated with

introduction of microbes into the lumen of the catheter with each entry into the system and with

needleless connector and administration set changes. Once formed, these intraluminal biofilms

can be disseminated into the bloodstream during infusions or when flushing, depending on the

tensile strength of the biofilms attached to the catheter surface.41,42

SUPPLIES AND EQUIPMENT

Needleless Connectors. Needleless connectors are frequently used as a part of the

infusion system. Failure to disinfect connectors or improper use of connectors can affect catheter

patency and increase risk of intraluminal contamination. There is a general lack of knowledge

among clinicians on types of needleless connectors, clamping sequence, and applications of

use.38,43

Disinfection Caps. A systematic review of the literature conducted in 2019 indicated that

the combined use of alcohol disinfection caps and alcohol wipes were associated with less CR-

BSIs than alcohol wipes alone.44 There continues to be confusion around the need for

disinfection of needleless connectors before accessing VADs even in the presence of passive

disinfection caps.

9
 Administration Sets. Administration sets are an integral component of the infusion

system. Proper care and management of VADs includes changing administration sets, add-on

devices, and needleless connectors at established intervals.16 Use of standard antiseptic nontouch

technique (ANTT®) provides guidance for connecting and disconnecting all components of the

infusion system, thus preventing contamination.45

VAD Dressings. Evidence-based guidelines recommend changing VAD dressings every

5 to 7 days when transparent dressings are used, at least every 48 hours for gauze dressings, and

immediately when the dressing becomes loose or soiled.16,46,47 Management of dressing integrity

and adherence has been shown to decrease the risk of CLABSI. In 1 study, multiple dressing

disruptions were associated with increased skin colonization upon catheter removal and the risk

of CLABSI increased 3- to 10-fold when this occurred.48 Though dressing adherence is

important, a randomized, controlled trial comparing the superiority of differing types of dressing

interventions for peripheral VADs demonstrated similar failure rates among all groups.49

COMMENTARY ON SIGNIFICANT FINDINGS

VAD-related complications are injurious to patients; clinicians must have fundamental

organizational resources available to safely perform VAD care and management. Organizations

must develop policies and procedures that address each type of VAD (peripheral or central),

vascular route (venous, arterial, intraosseous), and category (permanent, temporary, tunneled,

nontunneled), and outline steps for care and management. Organizational policies, procedures,

and practice guidelines must be based on current research findings and best evidence.16 Widely

published procedural resources may be used to develop policies and procedures but should not be

substituted for organization-specific policies.

10
 Organizations supporting clinicians who perform VAD care and management must create

processes for collecting, analyzing, and reporting quality outcome data including: VAD dwell

time, reasons for removal, and complications such as phlebitis, infiltration/extravasation,

thrombosis, and CR-BSI.16 Clinicians must collaborate with the infection prevention team to

analyze and disseminate quality outcome data to facilitate evidence-based best practices within

the organization. Based on the findings of this literature review, the following elements are

critical aspects of VAD care and management:

INFECTION PREVENTION
• Performance of hand hygiene immediately before accessing or caring for any VAD is imperative.
• Disinfect needleless connectors with every entry into the system and assess need for replacement.
Limit unnecessary entries into the infusion system.
• Alcoholic chlorhexidine is used for skin antisepsis prior to dressing placement when available.

VAD NECESSITY
• The interprofessional care team must meet daily to discuss VAD necessity, appropriateness,
complications, and future plans for vascular access.
• VADs must be removed immediately with an unresolved complication, discontinuation of infusion
therapy, or when no longer necessary for the plan of care.

VAD CARE AND MANAGEMENT

• Administration sets must be changed at established intervals based on infusate and when there is
question of contamination or loss of integrity.
• Administration sets must be protected from disconnection to maintain a closed system while in use.
• VAD dressing and engineered securement device (ESD) must be assessed daily for integrity and
adherence. Assess securement device for micro-motion, security and/or dislodgement. Change to a
new ESD or a different method of securement when absence of stability/security is identified. Note
dressing change date on label and plan accordingly.
• VAD dressing and ESD must be changed when damp, loose, or soiled and at intervals
recommended by the manufacturers’ direction for use.
• Assess device patency with every intermittent infusion and outline actions to restore patency when
occlusions occur.
• Assess patency of continuous infusions for clinical indications that the device is no longer
functional, or any complaint of discomfort.
• Evaluate risks/benefits for blood sampling from VAD.

11
RECOMMENDATIONS

INS asserts that a comprehensive organizational approach to VAD care and management

is imperative to ensure safe and efficacious patient care. An evaluation of current organizational

structures can help determine areas that need improvement (Table 1).

Policies and Procedures. Review organizational VAD policies and procedures; check to

ensure current reputable national standards and guidelines have been utilized to substantiate best

practice. Note the specific VADs and supplies described and compare with organizational

purchasing and supply lists to detect omissions or inclusion of products no longer used.

Determine if unique directions for use or special considerations for products/supplies used in the

organization merit inclusion in policy and procedure documents (Table 2). Establish a process to

foster clinician adherence and compliance with these organizational directives.

Quality Outcome Data. Review organizational VAD care and management quality

outcome data to ensure all measurable components are captured including, but not limited to

hand hygiene, CLABSI, CR-BSI, occlusion, thrombosis, phlebitis, extravasation, and infiltration.

These data inform leaders and clinicians where VAD care and management improvement is

needed when compared to similar organization’s comparable benchmarks and stated

organizational goals (Tables 1 and 3).

Documentation in Electronic Health Record. The electronic health record is an essential

tool for capturing VAD quality outcome data. Review documentation fields to ensure VAD

performance measures can be documented with specificity; see Table 1 for examples. Leaders

and clinicians must engage the health informatics team to build/modify the necessary

documentation fields.

12
 Clinician Education and Competency Records. Review documentation of clinician

education and competency status. All clinicians performing VAD care and management must be

educated according to organizational policy and procedures. Structures must be in place to meet

employee orientation needs, annual competency review, as well as just-in-time education that

addresses immediate changes in practice (Table 1).

CONCLUSION

Decidedly, health care organizations must be prepared to address lack of standardization

in VAD care and management. It is essential that each organization (1) develops policies and

procedures to align VAD care and management with recognized standards of practice; (2)

integrates unique aspects of organization-selected VAD care products into policies and

procedures and establishes expectations for adherence to these directives; (3) develops a

framework for gathering and analyzing clinical data related to patient outcomes for VAD care

and management; (4) utilizes quality outcome data to facilitate evidence-based best practices

within the organization; and (5) evaluates and facilitates educational programming to validate

clinician competency.

Approved by the INS Board of Directors April 2020.

13
TABLE 1. ORGANIZATIONAL EVALUATION FOR VAD CARE AND MAINTENANCE
Review Organizational
Policies and Procedures
•VAD policies and
procedures must be:
•Applicable to all types of
VADs managed in the
organization
•Based on current evidence
outlined in reputable
national standards and
guidelines for practice
•Designed to address all
selected VAD products used
in the organization
according to manufacturers'
instructions
•Structures must exist that
facilitate adherence and
compliance to these
organizational directives
Review Organizational Review VAD Documentation
Review Clinician Education
Outcome Data Related To Fields in Electronic Health
and Competency Records
VAD Care and Management Record
•Data must include VAD •The following items must be •Each clinician must have
metrics and complication documented: documentation of
statistics: •Insertion – date, vessel, site, education and competency
•Hand hygiene VAD type, gauge, French, validation for:
•CLABSI, CR-BSI lumens, dressing, clinician •VAD device selection and
•Occlusion •VAD assessment – site insertion
•Thrombosis inspection, dressing •VAD care and management
condition, securement, •VAD discontinuation
•Phlebitis
administration set, patency •VAD complication
•Extravasation, infiltration
•VAD necessity – daily management
assessment and plan for use •Medication administration
•VAD discontinuation - •Phlebotomy
reason for discontinuation
•Dressing change
•Administration set and add-
on change
•Complications -
interventions
•Infusate(s)
14
TABLE 2. VAD SUPPLY ORGANIZATIONAL POLICY AND PROCEDURE
DEVELOPMENT TOOL

Device/Supply Product/Type Manufacturers’ Instructions Patient Population and

Considerations for Use
Anti-infective
dressing
Arterial device
CVAD(s)
Dialysis catheter(s)
Disinfecting cap
Dressing dialysis
Dressing
PICC/CVAD
Dressing PIVC
Dressing port
Extension set
Filters
Hemostatic control
device/agent
Intraosseous device
Long PIVC
Midline catheter(s)
Needleless
connector
PICC(s)
Securement device
Sensitive skin
dressing
Short PIVC
Skin antisepsis
Skin protectant
Tape/adhesive
Tissue adhesive
Abbreviations: CVAD, central vascular access device; PICC, peripherally inserted central catheter; PIVC, peripheral intravenous catheter.

15
TABLE 3. ESSENTIAL VAD PRACTICE ELEMENTS AND DATA COLLECTION a
Clinical Practice Performance Measure
Component
Daily VAD Assessment Interprofessional team to assess
 Necessity
 Appropriateness
 Complications
 Ongoing plan
 Discontinuation
VAD site inspection
 Skin integrity, blisters, weeping
 Redness, erythema
 Pain with/without palpation, numbness
 Skin temperature
 Drainage from puncture site
 Swelling or inflammation
 CVAD/midline catheter external length
Dressing and securement
 Components are CDI
 VAD secure without motion
 Dressing is dated, not overdue for change
VAD Discontinuation Remove VAD immediately if
 Unresolved complication
 Discontinuation of infusion therapy
 No longer necessary for the plan of care
Ongoing Infection Infection prevention measures
Prevention Measures  Hand hygiene performed before
manipulation of infusion system
 Disinfect needleless connectors with each
entry into infusion system
 Limit unnecessary entries into infusion
system
 Prevent disconnection of administration
sets for continuous infusion
 Alcohol caps are applied appropriately (if
used)
 VAD dressing CDI, dated, current
Dressing Change and Dressing and securement practice
Securement  Sterile dressings are applied and
maintained on all VADs
 Change dressing at established intervals
according to dressing type
 Change dressing immediately if soiled,
damp, loose
 Perform site care and dressing change
using aseptic technique
 Use alcoholic chlorhexidine for skin
antisepsis (adults)
16
Data Collection
Documentation of team assessment
 Date, time
 Ongoing plan,
necessity/appropriateness
 Complications
 Removal, reason for
Documentation of VAD assessment
 Date, time
 Changes in CVAD/midline
catheter external length
 Complications/interventions
Documentation of dressing and
securement assessment
 Condition – dressing and
securement
Documentation of VAD removal
 Reason for removal
 Patient condition
 VAD condition
Perform routine surveillance
 Audit hand hygiene compliance
 Needleless connectors are
disinfected prior to access
 Administration sets are
connected, closed-systems
 Alcoholic caps applied where
appropriate
 VAD dressing is clean, dry, intact,
current
Documentation of dressing and
securement
 Performance of procedure, date,
type of antiseptic solution/type
of dressing
 Patient’s response to the
procedure
 Instructions given to the patient
 Clinical Practice Performance Measure Data Collection
Component
Administration Set Administration set change practice Documentation of administration
Change  Administration sets, including add-on set change
devices, are changed at established  Date and time
intervals depending on the type of  Labels applied
administration and infusate  Add-on devices placed including
 Change immediately when contamination needleless connectors/alcohol
is suspected or when product integrity is caps
compromised  Restart of infusates, rates and
 Minimize the number of manipulations programming checked
and entries into the system  If contamination is suspected,
 Label administration sets date of document event/occurrence
initiation or date of change describing situation and
 Label administration sets used for prescriber notification
medications that are administered via
specialized access devices (eg, intraspinal,
intraosseous, subcutaneous)

Patency, Flushing, and Patency, flushing and locking practice Documentation of patency
Locking  VADs are flushed and aspirated for a  Date and time assessed
blood return prior to each intermittent  Rate blood return (eg, brisk,
infusion to assess catheter function and sluggish)
prevent complications  Locking solution used and
 For continuous infusions, assess patency volume instilled
for any clinical indication that the device  Catheter clearance
is no longer functional, or any complaint performed/outcome of
of discomfort intervention
 VADs are flushed after each infusion to
clear the infused medication from the
catheter lumen
 VAD is locked after completion of the
final flush to decrease the risk of
intraluminal occlusion and CR-BSI
 Single-use flushing and locking systems
are used
 VAD patency is assessed using a 10-mL
syringe

Blood Sampling via VAD blood sampling practice Documentation of VAD blood
VAD  Assess risk vs benefit prior to using VAD sampling
for blood sampling  Decision process for blood
 Eliminate unnecessary laboratory tests sampling via VAD
 Reduce the frequency of obtaining blood
samples
 Draw blood samples based on clinical
need rather than a routine schedule

Abbreviations: CDI, clean, dry, intact; CVAD, central vascular access device; CR-BSI, catheter-related bloodstream infection; VAD, vascular
access device.

a
data derived from Gorski et al.16

17
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